The Morality Of Deceptive Communication In Physician-patient Relationship

Utility is promoted when people are safe and protected; in medicine this happens when a physician is able to focus on their main duty: treating the patient in harm. In order for this goal to be achieved, both patient and physician must remain physically and mentally sound, so that the treatment can be as effective and safe as possible. I agree with Kant’s premise that telling the truth is virtuous and doctors ought not objectively lie to a patient. However, because a physician-patient relationship is fiduciary, in situations where the status of the patient’s condition is uncertain, it can be morally permissible to communicate in a way that promotes the utility of both the patient and physician.

Unlike Kant’s deontological evaluation, I advocate that you approach the situation with a teleological perspective: assess the environment around you, determine the general psychological and physical status of the patient, try and calculate the level of certainty with which you could answer the patient’s question, and then focus on the possible outcomes of communicating different this knowledge. With this consequence-based view, I urge you to communicate in a way that promotes utilitarianism: maximizing the benefits and minimizing the harm done to every human in the helicopter (the physician, patient, piolet, etc.). As a physician, it is your responsibility to evaluate each circumstance individually and make a moral judgment based on the above guidelines.

Because there are various factors and multiple people to take into account in such a situation, you must address adress the individual impact, yet always keep in mind that your main priority is to do no harm. In David C. Thomasma’s paper “Telling the Truth to Patients: A Clinical Ethics Exploration,” he writes, “Although important, other primary values take precedence over the truth. The most important of these values is survival of the individual and the community”. This is a very important point that must be considered when determining how to communicate with your patient. I personally do not believe that one should explicitly lie, but I do believe that deception is morally permissible. What good is it to tell a hysterical patient that you have no idea if they will live? Sure, it might be the 100% truth, but that answer has the potential to jeopardize the not just the patient, but the whole crew.

I understand that circumstances very, so let us look at potential cases during which deception benefits all members of the operation. First, we will look at the case of 15-year-old Jenna who fell out of a tree You suspect a spinal injury, potentially a broken neck, and excessive bleeding from major lacerations. You are aware that a broken neck does not guarantee death, however, it is clear that she is in critical condition. After successfully transporting her into the helicopter, she begins to have a severe panic attack, and refuses to hold still making it difficult for the physician to treat the bleeding and hard for the nurses to keep her neck and back stabilized to prevent further injury. She screams, “Am I going to die!” What are you going to do?

If you tell Jenna the complete truth, “I don’t know, but maybe you’ll be lucky,” you could exacerbate the symptoms of her panic attack and decrease her chance of survival. As her nurse or physician, your goal is to calm Jenna down, and tend to whatever injuries you have the resources to treat. With this in mind, let’s go back and look at the guidelines I provided earlier. First, what is the environment like? It is clear that given the limited space of the craft and the condition of her injured back and neck, it is a priority to get Jenna to limit her movement and remain in a secure position. She is psychologically unstable as exhibited by her panic attack following the fall; and, as a result, her vital signs are worsening: her heart rate increasing, oxygen levels diminishing, loss of muscle control. At this point you are still uncertain of the extent of her injuries.

With this information, consider the possible outcomes of the various ways in which you could communicate with Jenna: would it behoove the patient to communicate with honest uncertainty or well-intended deception. If you follow Kant’s deontological approach and respond with “I do not know”, what are the potential consequences for Jenna and the other people in the helicopter? One possible consequence is the risk of exacerbating the panic attack. Consequently, if the panic attacks worsen then both Jenna and the physician could suffer because, in order for the physician to effectively treat Jenna, she must remain calm so that her injuries are accessible for the doctor to treat.

An alternative response could be responding with deception aimed to minimize Jenna’s panic. One response might involve communicating in a way that makes her feel valued and able, such as offering ways in which she, herself can help the doctor ‘keep her alive’. For example, one might say, “Jenna, right now we need you to help us help you. I will guide you step by step, but we really need your participation. First, it is important that you take deep breaths and so we can… xyz….”. This type of communication aims to divert her attention away from uncertainty and fear, give her a sense of control and purpose, and most importantly, help the doctor who is struggling to treat the critical injuries.

This type of deceptive communication is the utilitarian choice, for it maximizes the benefits and minimizes the harm for both Jenna and the physician: the doctor will have a better idea of what the injuries are, their current condition, the urgency with which they need to be addressed, and a stable body upon which to treat the injuries. Ergo, the physician benefits from this communication, as it gives him or her ability to work with greater precision and attention which minimizes potential harm caused by trying to work on an unstable patient. In the article On Telling Patients the Truth, Mack Lipkin states, “The crucial question is whether the deception was intended to benefit the patient or the doctor… (their) reputations and their livelihood depend on doing effective work; purely selfish reasons would dictate they do their best for their patients”. As you can see, communicating with a teleological perspective maximizes the physician utility, which in turn maximizes the benefits of every part involved.